For 2005, we are still planning to introduce the wireless, networked version of MedNet for Plum A+, as well as wireless MedNet for our PCA, or patient-controlled analgesia, platform.

In addition, two weeks ago, we announced a development agreement with Bridge Medical to create a new wireless, point-of-care medication management solution that will link our MedNet software with the Bridge MedPoint barcode-enabled point-of-care system. This is part of our strategy to develop products that can be seamlessly integrated, using an “open architecture” approach, to interface with the majority of hospital information systems. Our work with Cerner was our first partnership in this area, and Bridge represents an additional collaboration.

The FFC has agreed to delay plans to lift power restrictions on Airport Terminal Use (ATU) frequencies operating in the PLMR (Private Land Mobile Radio Services) band based on AHA concerns that relaxing current power limits could lead to harmful interference with wireless medical telemetry equipment.

“We will continue to take steps to protect medical telemetry from interference because it is used to protect the safety of life,” the agency said. The FCC in October 2002 proposed lifting the restrictions to improve communications at large airports. But in an order released Jan. 24, the agency said it agreed with the AHA medical telemetry task force's contention that allowing higher-powered ATU frequencies into the 460-470 MHz band would have a “negative impact” on wireless medical equipment operating in the band. The FCC said it will delay lifting the restrictions until Jan. 30, 2006, 30 days after an FCC freeze on high-powered users in the 460-470 MHz band expires.

Not mentioned is whether this move delays further adoption of PLMR band by commercial businesses. Business using PLMR radios for dispatch and service applications are much more likely to impact 460-470 MHz hospital telemetry systems — few hospitals are built close to airports.

Mary Beth Savary Taylor, the AHA's vice president for executive branch relations, …encouraged hospitals still operating in the 460-470 MHz band to move by the end of the year into the wireless medical telemetry service (WMTS) bandwith, which the FCC has set aside for medical telemetry equipment.

Someone should tell Mary Beth that there are two bands designated by both the FDA and the FCC for medical telemetry: WMTS and ISM. The article goes on for another four paragraphs about the necessity to switch to WMTS and mentions the “Dallas incident” of 1998 that started everything. Not once is ISM mentioned as an alternative to WMTS — a consistent oversight that is amplified and distorted by some medical device vendors.

Three vendors have fielded new proprietary access points based on the WMTS band. Little is known about their capacity, scalability or coexistance. Virtually every vendor with wireless medical devices also offers ISM wireless communications. Many factors effect wireless decisions: proprietary or open system, switching costs, trade-offs between recrystaled upgrades and new systems with new technology. Hospitals should be informed of all their choices by the association that is supposed to represent them.

Hospital capacity: depending on where you are, and who you ask, there's either too much or not enough.

The current building boom is being driven by factors including a shortage of beds created by consolidation; an aging population; a suburban population boom; and a desire to attract more patients by improving the quality of their stay.

In calling for the moratorium, Toussaint ( president of ThedaCare Inc. health care system) has specifically cited Aurora (Health Care)'s ongoing building program as a reason to put the brakes on construction. In addition to Aurora's plans to build a Waukesha County hospital, Aurora has opened hospitals in Green Bay and Oshkosh, despite concerns from local competitors about too many empty hospital beds in their communities.

Grabbing market share, upgrading facilities and adding more private rooms are also behind the boom/moratorium. Rising health care costs prompt some to ask if hospital construction is part of the problem. Over capacity raises hospital operating costs, but in today's capitated environment it is hard to pass this cost on to payers.

The extent to which hospital construction is to blame for the current level of health care spending is not really known. One Milwaukee-area hospital CEO told The Business Journal that a moratorium now is about five years too late, given the billions of dollars hospitals have spent on capital expansion over the past several years.

Major expansions are fraught with risk. And it looks like operating pressures on hospitals will only get worse.

The critical mass of projects — most expected to be financed through both capital campaigns and debt — from at least seven regional community hospitals comes even as more than 42 percent of the state's hospitals posted operating losses in 2004, with many more facing operating margins of less than three percent.

There is little argument that changing demographics and other factors will require greater hospital capacity than exists today; the question is when and how much.

Patient flow studies have demonstrated that increased patient velocity can significantly reduce the need for additional beds. Expanding areas that appear to be “capacity constrained” (ED, ICU, Telemetry) prior to patient flow studies and remediation, can result in over capacity and increased operating costs. Throwing capacity (or any other solution) at patient flow bottlenecks prior to thorough study usually results in pushing the bottleneck from one area to another, rather than eliminating it.

Generating more revenue from existing beds, and optimizing patient flow to minimize required expansions is advisable, especially for hospitals with thin or negative operating margins.

One of the key barriers to overcoming patient flow bottlenecks is the lack of feedback on what patient flow studies have shown are very fragmented activities and resources that surround the patient. If you can't measure it, how can you manage it? At the same time, information overload is a growing problem as we move from paper and phone driven processes to automated workflow. To be effective, users need the right information, in context, at the right time.

These are goals that all patient management software vendors share. A new vendor, awarix, has taken a decidedly different approach to meeting them.

Awarix was founded in 2003 by a group of industry veterans lead by Gary York. (His last company Emageon just went public.) They have built a product using the latest technology (always an advantage for the new guy). Their design philosophy differs considerably from previous patient flow software efforts. They have a reference site at St. Vincent’s Hospital in Birmingham.

The design objective for awarix was to create something that provides concise information, in the right context, at the right time. Additionally it had to be easy to learn and use, quick and easy to deploy, and easy to maintain and support. These design goals sound common enough, the result however is not.

Typical patient flow software solutions are dependant (sometimes highly dependant) on data entry by nurses, housekeeping, transport, and others, to drive the system. Awarix is driven by HL7 data from existing systems (orders, results, bed status, and ADT information) and location information provided by indoor positioning systems (tracking patients and assets). There is no IVR, no data entry devices, nor any running to the PC to enter an event. The system does provide messaging, but not to the granularity of a data capture oriented solution. This simplification results in less training, quicker deployment and more rapid user adoption.

Out in the hospital large flat panel displays show that area's floor plan with icons and color coded workflow and status. At a glance anyone on the unit can see what rooms are occupied, rooms with planned discharges, rooms to be cleaned, and patients with orders or results. Patient safety indicators can also be displayed – NPO, isolation, monitored patient, patient with IV, etc. Icons can also show new orders, stat orders, and patients who need to have vitals captured.

For management, there are KPI (key performance indicators) dashboard displays that provide a summary view of current operations. There are also retrospective reports that can be run. Tailored views of data are available for the usual suspects: bed management, housekeeping, case managers, unit managers and administrators.

Combined with an indoor positioning system awarix can display real time asset and patient locations. Displays show in real-time when patients are leaving the unit, are in a diagnostic unit, or where that last IV pumps is hiding. They've integrated with Radianse, but are IPS agnostic.

Awarix is sold as a web-based information appliance rather than a software application. The appliance uses a web server, so a browser is all that’s needed to interact with. It is written in Java and runs on Linux. The appliance uses a service object architecture (to the cognoscenti, SOA) and web services to facilitate systems integration and extensibility. Scalability and high availability is achieved by adding additional appliances. Awarix is not a system of record, and does not include a data repository. Data can be exported for archival via web services. By packaging their solution as an appliance, they have eased deployment, service and reduced TCO (total cost of ownership).